Region no stranger to drug shortage woes

Reports of pharmaceutical drug shortages by SouthCoast medical professionals offer a local glimpse into what's become a widespread problem.

ANIKA CLARK

Reports of pharmaceutical drug shortages by SouthCoast medical professionals offer a local glimpse into what's become a widespread problem.

Lately, "what we've been having issues with are fentanyl, Versed, Ativan ...," said Ken Eugenio, pharmacy manager at St. Luke's and Tobey hospitals.

These medications, which can be used, respectively, for pain ­— or for the latter two — for agitation, anxiety, seizures and to induce sedation, "are ones that we use routinely — day in, day out — to help manage patients. And those recently have been in short-supply" he said.

Although he said a particular drug might not be available, period, "more often than not, we can't get (a drug) the way we normally get it," according to Eugenio. A medication might be available in a syringe versus a vial, he said or in a different concentration, but "each time we change that, we introduce, potentially, the chance of error — where it looks different than what people are used to."

And when pharmacy staff have to draw out a smaller dose from a larger quantity, that just adds additional steps.

This can also be a problem because the repackaging can reduce a drug's shelf life, according to Steve Arruda, deputy director of emergency medical services for the city of New Bedford.

"We end up wasting a lot of it when they give us the large packaging," said Arruda, who said that when the city's ambulances administer drugs to patients taken to Southcoast hospitals, they're replenished there on a one-to-one basis.

At Brewster Ambulance Service, which serves Bristol, Plymouth and Norfolk counties, along with Metro-Boston, "we have never had a problem with not being able to get something to a patient," said Danny Thomas, director of quality assurance, who said the shortage issue's not a new problem and is "industry-wide."

Similarly, for Acushnet ambulances, "so far, none of the shortages have affected our service's delivery of care," said Kevin A. Gallagher, chief of the Acushnet Fire and EMS Department, who said his ambulances restock at St. Luke's.

"But we're still very concerned that a shortage may be coming down the pike that's going to force us to deal with the unknowns that that may bring," he said.

Like Gallagher, Andrew Pappas — EMS director at STAT-SouthCoast EMS in Dartmouth — said having reserves of the drugs has helped shield the company from the shortages' stings. But, he said, "we have had a shortage in our fentanyl" and other medications.

Meanwhile, reserves won't last forever.

"All these drugs have a shelf life," Gallagher said. "Eventually it's going to expire and need to be replaced."

At Saint Anne's Hospital in Fall River, which is part of the Steward Health Care System, "Andrew Dousa, our director of pharmacy services, has confirmed that we are experiencing some shortages, or have orders that are on back order — essentially the same as other hospitals in the area and throughout Steward (and across the country)," spokeswoman Anne Ferreira wrote in an e-mail. "However, by working together — within the community and throughout the Steward network — we are able to provide the drugs that are needed, when they are needed, for our community's patients."

At St. Luke's and Tobey hospitals, Eugenio offered some strategies for weathering the shortage storm.

As part of the Southcoast Hospitals Group, supplies of medications can be shifted where needed within each hospital and throughout the system, he said, adding that if a drug's completely depleted in a dire situation, Southcoast would seek it from an outside facility.

A patient might be switched sooner, if possible, to an oral form of a medication from an intravenous one if the latter's in short-supply, he said. When a generic drug can't be found, pharmacies may be forced to buy its pricier brand name version.

And when a drug's unavailable in any form? Providers might have to substitute, according to Eugenio.

"There was a point a few weeks ago, we'd run out of fentanyl. So the doctors did have to use a different analgesic," Eugenio said.

But regardless, he said it's Southcoast's practice to avoid the so-called "gray market."

"They won't tell us where they got (the drugs) from," he said. And "you're not sure how it's been stored. ... It's a safety concern."

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